Homestead_Gaskins.� rt.�
, t CLAIM FOR HOMESTEAD PROPERTY TAX
- � � CREDIT/STANDARD DEDUCTION
♦ � • � State Fwm 5473 (RS / 70-01)
Prescribed by ihe Department oF Local Govemment Finance
INSTRUCTIONS: See reverse side lor (ling insfrucfions.
FORM 1'% YEAR
HC10
- W.. c,� �+'.. a x f. .' --- ....;: z..:-.
_ _3..3�'.�: - - .a " _ .'a'LT -�?.,� +_c.: .. �ty . �v`z,., r ^- - .
��e) c Ih on e tst�,p��y�of ar ��20
I(We) occupie as our p6ncipal place of reside e Ihe following descnbed real property for which a Homes�r�r(�Crle�di �at " re Gaimed:
�(VJe) owned ❑ Are buying under contracl F� o �����
Have a benefidal interest in the enti that is Iiable for the ro e taxes on Ihe ro e �
ty p p rty p p rty and ihai owns the property or is u der a conVact.
I( buying om m�Vact, Fee Simplo ownets name
Recorders olfice where contraa is recorded
Tavnship
Tating
Record number � Page
ra(en numcer e a cn Is Ne property in uestian: V
�—OO i�o I—� ��� /� 3- ll 3. cb � eal property Mobile Homo p.C. 67.7-7)
If any portion of Ne residential sWCWre w the land not axceeding one (7 ) aue lhat immediately sunounds ihat sWCWre is used to produce income, desaihe the use antl portion
of the property uUlized W produce income.
�ii v ii !��i i i i ei ����ii i�
�� ���'�`�^"`-"��'��'�' ��'9�'�i-� -� TRUE TAX i� ASSESSED VALUE HOMESTEAD �r-F�+ NON RESIDENTIAL'�rn �� �'•
{, ''�`"�`''.h`�„ � ASS�$�S� �'i:�.tS��Y.�_ er�:ri>� ��fVALUE'�`ia�, .+AT 100°/_� Nt 7v+is�VALUEs'�rn �'.s� �s'VALUE�-�'-��? �``3
»rY�,a.�.� r s...-,.rFF��e::. .-sx..� xesiki�
Land not exceeding 1(one) acre immediately F_ ks ��3'�"'���'i j'?�?-� �'� ��" r=
surrounding residential improvemenLS. (� ) ys-� ,tag�,�r ��Lr � .�.a �w .Y
�
�,�-:�_ �--��aw: � -
Other land �Z� '= `-� �:t. SS�': �o:.�9s
=r4�_ y� .
. �,�,�"-E.'?%i" ?_3
Total land (line 1 plus line 2) (g�
� f F us �' �,�'' f v
Dwellin9 (4) a�t�c"<�5.�''',' s'����:�4'�i��_�-
Residential improvements =�.`'�"�"t�-����.�'` '��-° �`'s
Garege (5) �e��.c�ir�,�� '�` �'�4' �'
,—..`Li -�"'^y's':`?. � � � �
Otherimprovements (6) ��` k"���`u T
� .;c�sr w
Tdal improvements Qine 4 through line 6) (�)
Tdal vatue (line 3 phs line n (g�
I hereby certify U7e above is We, correG, and Signature of Assessor Date s'gnea
complete.
Veti� aclion - SignaWre ofAuditor Date sgned
20_Pay20_
Lesser of 7!2 Homestead
_ Valuation or 56,000
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